The development and validation of static and adaptive screeners to measure the severity of panic disorder,social anxiety disorder,and obsessive compulsive disorder

A series of static and adaptive screeners for panic disorder, social anxiety disorder (SAD), and obsessive compulsive disorder (OCD) were developed and compared using data‐driven methods to facilitate the measurement of each disorder in community samples. Data comprised 3175 respondents for the development sample and 3755 respondents for the validation sample, recruited independently using Facebook advertising. Item Response Theory (IRT) was utilized to develop static continuous screeners and to simulate computerized adaptive algorithms. The screeners consisted of a small subset of items from each bank (79% reduction in items for panic disorder, 85% reduction in items for SAD, and 84% reduction in items for OCD) that provided similar scores (r = 0.88–0.96). Both static and adaptive screeners were valid with respect to existing scales that purportedly measure similar constructs (r > 0.70 for panic disorder, r > 0.76 for SAD, and r > 0.68 for OCD). The adaptive scales were able to maintain a higher level of precision in comparison to the static scales and evidenced slightly higher concordance with scores generated by the full item banks. The screeners for panic disorder, SAD, and OCD could be used as a flexible approach to measure and monitor the severity of psychopathology in tailored treatment protocols.     

A transdiagnostic comparison of trauma and panic memories in PTSD, panic disorder, and healthy controls

Inadequate processing of trauma information is considered to lead to particularly vivid recollections and disorganized memories of the trauma. Although trauma memories have mainly been investigated in PTSD, memories in other psychiatric disorders may actually share some characteristics. This may particularly be true for patients with panic disorder with agoraphobia (PDA) as a first panic attack resembles trauma. To test this hypothesis, PTSD trauma memories (n = 59) were compared with PDA panic memories (n = 58), and trauma memories of healthy trauma victims (n = 135) on self-reported re-experiencing and disorganization. PTSD trauma memories had more re-experiencing elements than memories of the other two groups, although PDA memories had more re-experiencing elements than the controls' trauma memories. Relative to the controls, PTSD and PDA memories were disorganized. Peritraumatic dissociation and current memory-associated dissociation were also high in PTSD and PDA patients compared to the controls. Implications of these results are discussed.     

Anxiety disorders and obsessive compulsive disorder 9 months after perinatal loss

ObjectivePerinatal loss (stillbirth after 20 weeks of gestational age or infant death in the first month) impacts one to two infants per hundred live births in the United States and can be a devastating experience for parents. We assessed prevalence of anxiety disorders and obsessive compulsive disorder (OCD) among bereaved and live-birth mothers.MethodsWe collaborated with the Michigan Department of Community Health to survey Michigan mothers with perinatal death or live birth. We measured symptoms of generalized anxiety disorder, social phobia, panic disorder and OCD using validated written self-report screens and collected data on maternal demographics, psychiatric history, social support and intimate partner violence.ResultsA total 609/1400 mothers (44%) participated, returning surveys 9 months postdelivery. Two hundred thirty-two mothers had live birth, and 377 had perinatal loss. In unadjusted analyses, bereaved mothers had higher odds of all four disorders. In logistic regression adjusted for covariates, bereaved mothers still had higher odds of moderate–severe generalized anxiety disorder [odds ratio (OR): 2.39, confidence interval (CI): 1.10–5.18, P= .028] and social phobia (OR: 2.32, CI: 1.52–3.54, P< .0005) but not panic disorder or OCD.ConclusionBereaved mothers struggle with clinically significant anxiety disorders in the first year after perinatal loss; improved identification and treatment are essential to improve mental health for this vulnerable population.     

Anxiety and major depression comorbidity in a family study of obsessive-compulsive disorder

To understand the familial relationship between obsessive-compulsive disorder (OCD), other anxiety disorders, and major depressive disorder (MDD), we examined the rates of anxiety disorders and MDD in first-degree relatives of OCD probands and controls, the association between age at onset of OCD and the occurrence of other anxiety disorders and major depressive disorder in relatives of probands, and the co-transmission of specific anxiety disorders, MDD, and OCD within families of probands. Recurrence risks were estimated from 466 first-degree relatives of 100 probands with OCD and 113 first-degree relatives of 33 non-psychiatric controls. Rates of non-OCD anxiety disorders and MDD were comparable in relatives of OCD probands and controls. Rates of anxiety disorders and MDD were higher among case relatives with OCD than among case relatives without OCD and control relatives. Fifty percent of case relatives with OCD had at least one comorbid anxiety disorder. Early age at onset (<10 years) in probands was associated with higher rates of anxiety and depression comorbidity among case relatives with OCD but not among case relatives without OCD. The occurrence of specific anxiety disorders and MDD in case relatives was independent of the same comorbid diagnosis in the OCD probands. OCD, panic disorder, generalized anxiety disorder, and MDD occurred together more often than expected by chance among individuals with OCD. Furthermore, age at onset in probands is associated with specific anxiety and affective comorbidity among case relatives. These findings support the hypothesis that early- and late-onset OCD represent different etiologic variants.     

Recollections of parent-child relationships in patients with obsessive-compulsive disorder and panic disorder with agoraphobia

Objective: In previous studies, patients with different psychiatric conditions, as compared with matched controls, have reported that their parents were more protective and less caring towards them when they were children. However, studies investigating associations between parental behaviours and anxiety disorders have yielded inconsistent results. The aim of this study was to compare recalled parental behaviours in out‐patients with obsessive‐compulsive disorder (OCD), in out‐patients with panic disorder with agoraphobia (PDA), and in non‐anxious controls. Method: The sample included 43 out‐patients with OCD, 38 with PDA, and 120 controls. Participants completed the Parental Bonding Instrument and the Egna Minnen Beträffande Uppfostran or Own Memories of Parental Rearing Experiences in Childhood. Results: No differences were found between the two anxious groups. However, compared with the control group, anxious patients recalled their parents as more protective. Conclusion: Our findings suggest that child rearing practices such as overprotection may be a risk factor in the development of anxiety disorders.     

Body temperature in patients with panic disorder treated with escitalopram

The aim of the study was to investigate the influence of escitalopram on peripheral body temperature (PBT) in panic disorder. In a 4 week case–control study (N = 12 female patients; N = 12 matched healthy controls), the daytime PBT declined compared to night time PBT in patients. The prospective relationship between PBT and panic disorder shows a decline of daytime PBT compared to the night time PBT in panic disorder from week 2 of treatment with escitalopram onwards. The effect of escitalopram on daytime PBT may have occurred through an activation of the sympathetic system.     

DSM-III-R Axis I and II disorders in agoraphobic patients with and without panic disorder

Patients attending an inpatient phobia treatment program were diagnosed for DSM-III-R Axis I and II disorders, using the Structured Clinical Interview for DSM-III-R Disorders, and completed a set of self-report instruments. They were divided into 3 groups: (a) those who met the criteria for panic disorder with agoraphobia (n= 57), (b) those who met the criteria for agoraphobia without a history of panic disorder (n= 21), and (c) those who met criteria for other anxiety disorders, but not for panic/agoraphobia (n= 14). On Axis I, more of the panic with agoraphobia than of the agoraphobia without panic patients had obsessive-compulsive disorder. On Axis II, no significant differences between the agoraphobic patients with and without panic occurred. However, the number of hysterical traits was related to the presence of panic disorder among the agoraphobic patients. Avoidant and dependent traits were related to symptom severity.     

Attention bias in adults with anorexia nervosa,obsessive-compulsive disorder,and social anxiety disorder

BackgroundAttention bias to threat (selective attention toward threatening stimuli) has been frequently found in anxiety disorder samples, but its distribution both within and beyond this category is unclear. Attention bias has been studied extensively in social anxiety disorder (SAD) but relatively little in obsessive compulsive disorder (OCD), historically considered an anxiety disorder, or anorexia nervosa (AN), which is often characterized by interpersonal as well as body image/eating fears.MethodsMedication-free adults with SAD (n = 43), OCD (n = 50), or AN (n = 30), and healthy control volunteers (HC, n = 74) were evaluated for attention bias with an established dot probe task presenting images of angry and neutral faces. Additional outcomes included attention bias variability (ABV), which summarizes fluctuation in attention between vigilance and avoidance, and has been reported to have superior reliability. We hypothesized that attention bias would be elevated in SAD and associated with SAD severity.ResultsAttention bias in each disorder did not differ from HC, but within the SAD group attention bias correlated significantly with severity of social avoidance. ABV was significantly lower in OCD versus HC, and it correlated positively with severity of OCD symptoms within the OCD group.ConclusionsFindings do not support differences from HC in attention bias to threat faces for SAD, OCD, or AN. Within the SAD sample, the association of attention bias with severity of social avoidance is consistent with evidence that attention bias moderates development of social withdrawal. The association of ABV with OCD diagnosis and severity is novel and deserves further study.     

Pre- and perinatal complications in relation to Tourette syndrome and co-occurring obsessive-compulsive disorder and attention-deficit/hyperactivity disorder

Pre- and perinatal complications have been implicated in the onset and clinical expression of Tourette syndrome albeit with considerable inconsistencies across studies. Also, little is known about their role in co-occurring obsessive-compulsive disorder (OCD) and attention–deficit/hyperactivity disorder (ADHD) in individuals with a tic disorder. Therefore, we aimed to investigate the role of pre- and perinatal complications in relation to the presence and symptom severity of chronic tic disorder and co-occurring OCD and ADHD using data of 1113 participants from the Tourette International Collaborative Genetics study. This study included 586 participants with a chronic tic disorder and 527 unaffected family controls. We controlled for age and sex differences by creating propensity score matched subsamples for both case-control and within-case analyses. We found that premature birth (OR = 1.72) and morning sickness requiring medical attention (OR = 2.57) were associated with the presence of a chronic tic disorder. Also, the total number of pre- and perinatal complications was higher in those with a tic disorder (OR = 1.07). Furthermore, neonatal complications were related to the presence (OR = 1.46) and severity (b = 2.27) of co-occurring OCD and also to ADHD severity (b = 1.09). Delivery complications were only related to co-occurring OCD (OR = 1.49). We conclude that early exposure to adverse situations during pregnancy is related to the presence of chronic tic disorders. Exposure at a later stage, at birth or during the first weeks of life, appears to be associated with co-occurring OCD and ADHD.     

Infant distress to novelty is associated with maternal anxiety disorder and especially with maternal avoidance behavior

Research suggested that maternal anxiety disorders might be related to infants’ behavioral inhibition. This study investigated whether maternal postpartum anxiety disorder is associated with infant temperament, more precisely, infant distress to novelty, an early predictor of behavioral inhibition. Differences in the latter were analyzed in a German sample by comparing n = 38 healthy mother–infant dyads to n = 44 dyads comprised of mothers diagnosed with a DSM-IV anxiety disorders. Infant age ranged from 2.83 to 7.97 months. Infant temperament was measured by means of the Infant Behavior Questionnaire. Mothers were screened for postpartum anxiety disorder using the Structured Clinical Interview for DSM-IV Disorders. Severity of anxiety was measured by self-reported questionnaires (Anxiety Cognition Questionnaire, Body Sensations Questionnaire and Mobility Inventory). Infant salivary cortisol reaction when being confronted with a socio-emotional stressor (Face-to-Face-Still-Face paradigm) was assessed to validate infant distress. A Mann–Whitney-U analysis suggested that infants of mothers with an anxiety disorder show more distress to novelty than infants of healthy mothers. Furthermore, data reveal a positive Spearman's ρ-correlation between infant distress to novelty and maternal avoidance behavior (Mobility Inventory). A strong correlation between infant cortisol reactivity and reported distress to novelty validated the maternal evaluation of infant temperament in our sample. Results suggest a possible approach to promote infant development by encouraging mothers with anxiety symptoms to encounter feared stimuli.     

Comorbidity,age of onset and suicidality in obsessive–compulsive disorder (OCD): An international collaboration

ObjectivesTo collate data from multiple obsessive–compulsive disorder (OCD) treatment centers across seven countries and five continents, and to report findings in relation to OCD comorbidity, age of onset of OCD and comorbid disorders, and suicidality, in a large clinical and ethnically diverse sample, with the aim of investigating cultural variation and the utility of the psychiatric diagnostic classification of obsessive–compulsive and related disorders.MethodsResearchers in the field of OCD were invited to contribute summary statistics on current and lifetime psychiatric comorbidity, age of onset of OCD and comorbid disorders and suicidality in their patients with OCD.ResultsData from 3711 adult patients with primary OCD came from Brazil (n = 955), India (n = 802), Italy (n = 750), South Africa (n = 565), Japan (n = 322), Australia (n = 219), and Spain (n = 98). The most common current comorbid disorders were major depressive disorder (28.4%; n = 1055), obsessive–compulsive personality disorder (24.5%, n = 478), generalized anxiety disorder (19.3%, n = 716), specific phobia (19.2%, n = 714) and social phobia (18.5%, n = 686). Major depression was also the most commonly co-occurring lifetime diagnosis, with a rate of 50.5% (n = 1874). OCD generally had an age of onset in late adolescence (mean = 17.9 years, SD = 1.9). Social phobia, specific phobia and body dysmorphic disorder also had an early age of onset. Co-occurring major depressive disorder, generalized anxiety disorder and psychotic disorders tended to have a later age of onset than OCD. Suicidal ideation within the last month was reported by 6.4% (n = 200) of patients with OCD and 9.0% (n = 314) reported a lifetime history of suicide attempt.ConclusionsIn this large cross-continental study, comorbidity in OCD was common. The high rates of comorbid major depression and anxiety disorders emphasize the need for clinicians to assess and monitor for these disorders. Earlier ages of onset of OCD, specific phobia and social phobia may indicate some relatedness between these disorders, but this requires further study. Although there do not appear to be significant cultural variations in rates or patterns of comorbidity and suicidality, further research using similar recruitment strategies and controlling for demographic and clinical variables may help to determine whether any sociocultural factors protect against suicidal ideation or psychiatric comorbidity in patients with OCD.     

Probabilistic reasoning in patients with body dysmorphic disorder

Background and Objectives

Many patients with body dysmorphic disorder (BDD) have poor insight into their condition. Indeed, their conviction in their ugliness is often delusional. Perhaps the most robust information-processing abnormality associated with delusions is a jumping to conclusions (JTC) reasoning bias such that delusional individuals request significantly less information before making a decision relative to healthy controls. We investigated whether patients with BDD (n = 20) demonstrate a JTC reasoning style relative to patients with OCD (n = 20) and healthy controls (n = 20).

Methods

Participants completed a clinician-rated measure of delusionality and two tests of probabilistic reasoning: the beads task and the survey task.

Results

Patients with BDD did exhibit higher delusionality than the patients with OCD. They did not, however, exhibit a JTC reasoning bias relative to the patients with OCD or the healthy controls. Patients with poor insight BDD requested significantly less information before making a decision than did patients with fair insight BDD.

Limitations

The clinical groups were characterized by multiple comorbidities and concomitant medications. The BDD group had relatively good insight as compared to other studies examining delusionality in BDD.

Conclusions

Taken together, our results suggest that although a JTC reasoning bias was not present in all patients with BDD, a modest JTC reasoning bias may be present among patients with poor insight BDD. Future studies could provide additional information on this hypothesis.     

Parental psychopathology in child and adolescent obsessive-compulsive disorder

Purpose To identify the lifetime prevalence of obsessive-compulsive disorder (OCD) and other psychiatric diagnoses in parents of OCD pediatric patients as well as the frequency of onset of psychiatric disorders in the 6 months prior to evaluation. Methods Parents (n = 63) of 32 children and adolescents (20 males and 12 females; mean age of 13.3 ± 2.4) with OCD and parents of (n = 63) 32 age and sex-matched controls with no psychiatric diagnosis were examined. The semi-structured SCID-I was used to identify axis I psychiatric disorders and SCID-II to evaluate personality disorders. Results Mothers of patients had significantly more psychiatric diagnoses than control mothers (P = 0.001). Only parents of patients had diagnosis of OCD (P = 0.01) and psychiatric diagnosis (Adjustment Disorders, Major Depression, Anxiety Disorders) with onset during the 6 months prior to evaluation (P = 0.001). The duration of disease in children appeared to be related to development of morbidity in parents (P = 0.04). Parents of patients also showed a higher incidence of personality disorders (P = 0.01), in particular avoidant (6 versus 1 parents, P < 0.055) and obsessive-compulsive (9 versus 2 parents, P = 0.016) personality disorders. Conclusions The findings suggest that there may be an excess of psychopathology in parents of children with OCD as compared to parents of pediatric and non-psychiatric patients. Adjustment disorders with depressive and anxious symptoms are significantly more frequent in mothers of OCD children after the onset of the disease.     

Is disgust proneness sensitive to treatment for OCD among youth?: Examination of diagnostic specificity and symptom correlates

Although disgust proneness has been implicated in obsessive-compulsive disorder (OCD), there is a paucity of research examining change in disgust proneness during treatment as well as the correlates of such change, especially in children. This study examined the relationship between changes in disgust proneness and disorder-specific symptoms during residential treatment among youth with OCD, anxiety, and mood disorders. Youth ages 12–18 (n = 472) completed pre- and post-outcome measures of OCD, anxiety, and mood symptoms and disgust proneness. Results indicate that although disgust proneness decreases during treatment for youth with OCD, anxiety, and mood disorders, youth with primary OCD experienced the greatest decrease in disgust proneness over the course of treatment. Reductions in disgust proneness during treatment were significantly correlated with reductions in multiple symptom measures, with the strongest correlations between reductions in disgust proneness and OCD symptoms. Implications and directions for future research are discussed.     

Overlapping and Distinctive Features of Hypochondriasis and Obsessive–Compulsive Disorder

The spectrum of obsessive–compulsive disorders has received a great deal of theoretical attention, but there has been relatively little associated empirical research. The purpose of this study was to compare three groups of patients; those diagnosed with hypochondriasis (HC, a proposed spectrum condition), obsessive–compulsive disorder (OCD) and those with both OCD and HC (OCD/HC). The results show that patients with HC scored highest on a measure of overvalued ideas, and that the HC and HC/OCD groups scored significantly higher on measures of panic and agoraphobic cognitions. The groups also differed significantly for symptoms associated with compulsions. The patient groups were not different for measures of obsessions, depression, and anxiety. The results provide partial support for inclusion of HC in the spectrum of obsessive–compulsive disorders, but also provide indirect support for the association between HC and panic disorder. These results are interpreted in light of distinguishing characteristics among obsessive–compulsive spectrum conditions.     

The loudness dependence of the auditory evoked potential (LDAEP) in schizophrenia,bipolar disorder,major depressive disorder,anxiety disorder,and healthy controls

Background

Serotonergic dysfunction in schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, and healthy controls was evaluated by measuring the activity of the loudness dependence of the auditory evoked potential (LDAEP).

Methods

The 357 subjects who were evaluated comprised 55 normal controls, 123 patients with major depressive disorder, 37 with bipolar disorder, 46 with schizophrenia, 37 with panic disorder (PD), 31 with generalized anxiety disorder (GAD), and 28 with post-traumatic stress disorder (PTSD).

Results

LDAEP was significantly stronger in healthy controls than in patients with either bipolar disorder (p = 0.025) or schizophrenia (p = 0.008), and significantly stronger in patients with major depressive disorder than in those with bipolar disorder (p = 0.01) or schizophrenia (p = 0.03). LDAEP did not differ significantly between patients with major depressive disorder and healthy control subjects (p = 0.667), or between healthy control subjects and patients with anxiety disorder, including PD (p = 0.469), GAD (p = 0.664), and PTSD (p = 0.167).

Conclusion

The findings of the present study reveal that patients with major psychiatric disorders exhibit different strengths of LDAEP according to their serotonin-related pathology. Studies controlled for psychotropic medication, menstruation cycle, and smoking are needed.     

Low implicit self-esteem and dysfunctional automatic associations in social anxiety disorder

Background and ObjectivesNegative automatic associations towards the self and social cues are assumed to play an important role in social anxiety disorder. We tested whether social anxiety disorder patients (n = 45) showed stronger dysfunctional automatic associations than non-clinical controls (n = 45) and panic disorder patients (n = 24) and whether there existed gender differences in this respect.MethodsWe used a single-target Implicit Association Test and an Implicit Association Test to measure dysfunctional automatic associations with social cues and implicit self-esteem, respectively.ResultsResults showed that automatic associations with social cues were more dysfunctional in socially anxious patients than in both control groups, suggesting this might be a specific characteristic of social anxiety disorder. Socially anxious patients showed relatively low implicit self-esteem compared to non-clinical controls, whereas panic disorder patients scored in between both groups. Unexpectedly, we found that lower implicit self-esteem was related to higher severity of social anxiety symptoms in men, whereas no such relationship was found in women.ConclusionsThese findings support the view that automatic negative associations with social cues and lowered implicit self-esteem may both help to enhance our understanding of the cognitive processes that underlie social anxiety disorder.     

Temperament and character among Korean children and adolescents with anxiety disorders

The purpose of this study was to evaluate the temperament and character of children and adolescents with anxiety disorders in samples from Korean community. The study subjects were children and adolescents diagnosed with social phobia (n = 66), separation anxiety disorder (n = 47), specific phobia (n = 415), and obsessive–compulsive disorder (n = 42) with the diagnostic interview schedule for children, version IV (DISC-IV) in representative community samples. Among these, we excluded other psychiatric disorder comorbid samples, with the exception of externalizing disorders. We assessed the subjects of each anxiety group using the junior temperament and character inventory (JTCI). Social phobias were significantly associated with high harm avoidance and low self-directedness on the JTCI. The association of specific phobias with high harm avoidance, and obsessive–compulsive disorder with low self-directedness was also significant. Separation anxiety disorder was not associated with any temperament and character on the JTCI. Children and adolescents with anxiety disorders have different temperaments and character profiles in accordance with diagnostic groups, which implies the specific pathophysiological mechanism of each anxiety disorder.     

Markers of vulnerability to obsessive-compulsive disorder in an ultra-high risk sample of patients who developed psychosis

Aims: The study aims to identify markers of vulnerability to obsessive–compulsive disorder (OCD) in an ultra‐high risk sample of patients who developed psychosis. Methods: Three hundred and eleven patients at ultra‐high risk for psychosis were examined at baseline and after a mean of 7.4 years follow‐up. Patients who developed psychosis with OCD (PSY + OCD; n = 13) and psychosis without OCD (PSY − OCD; n = 45) were compared in terms of socio‐demographic and clinical features. Results: PSY + OCD patients displayed greater severity of depression before and after conversion to PSY + OCD, and increased rates of depressive disorders before exhibiting PSY + OCD. However, they only displayed greater severity of anxiety and increased rates of non‐OCD anxiety disorders after psychosis. Further, PSY + OCD patients were more likely to report a positive family history for anxiety disorders than PSY − OCD. Conclusion: Although depression and a family history of anxiety disorder may act as vulnerability markers for OCD in psychosis, the resulting anxiety may be a correlate or a consequence of PSY + OCD.